Poll: How doctors feel about compassionate use

A patient lies on death’s door. His physician knows of a promising drug in clinical trials that could save his life, but there is no FDA approval, no final results. Should compassionate use be allowed to save a patient’s life?

We posed this question to the SERMO community recently; the results and discussion shed light on physician sentiment.

Should compassionate use be allowed for unproven drugs or therapies?

74% Yes, but only when the patient has no other options

19% Yes, clinical trials take too long

7% No, it’s unethical to do so

What Doctors Think of Compassionate Use

In the wake of Ebola and the use of experimental treatment options and rushed vaccine trials, many doctors discussed the pros and the cons. A family practitioner wrote, “As with almost everything in medicine, you weigh the risk of the treatment and the disease to the benefit and try to make an intelligent decision. In Ebola, the risk of the disease is astronomical, so even a little benefit or a potential benefit is acceptable. If the benefit is essentially zero, as in many alternative treatments, then even a small risk of treatment outweighs and precludes its ethical use. “

A surgeon countered, “these treatment options are offered at a time when coercion is remarkably easy. “What have you got to lose? Are you going to miss out on a potential cure?” and worse, to families, “Are you gonna let money stand between you and the chance to save your parent/spouse/child?”

“Compassionate use has to be offered in a VERY circumspect fashion, and patient and family must be treated as fairly as possible,” he continued. “And frankly, I’m not sure that playing fair with families, in this situation, is EVER possible.

A second family practitioner talked about private insurance decision-making. “I was frequently presented this question when I was in charge of medical policy for a large insurance company. Cost was not the main consideration; plausibility was. This is, there had to be a good reason to believe the proposal could work.”

Several doctors voiced the need to take profit out of the equation when making these tough decisions. An internist wrote, “compassionate use should be mediated through the 340B drug program to avoid profiteering from a serious illness scenario.”

As a physician, what do you think about compassionate use? Has the recent Ebola crisis and the experimental drugs used on some patients changed your perspective? Have you ever had the opportunity to assist a patient through a compassionate use scenario? We discuss this and a myriad of clinical topics inside SERMO, if you’re an M.D. or D.O., please join us.